The Effects of Intracranial Stenosis on Cerebral Perfusion and Cognitive Performance

Background: Intracranial stenosis (ICS) may contribute to cognitive dysfunction by decreased cerebral blood flow (CBF) which can be measured quantitatively by arterial spin labelling (ASL). Interpretation of CBF measurements with ASL, however, becomes difficult in patients with vascular disease due to prolonged arterial transit time (ATT). Recently, spatial coefficient of variation (sCoV) of ASL signal has been proposed that approximates ATT and utilized as a proxy marker for assessment of hemodynamic status of cerebral circulation. Objective: We investigate the association of ICS with CBF and sCoV parameters and its eventual effects on cognition in a memory clinic population. Methods: We included 381 patients (mean age = 72.3±7.9 years, women = 53.7%) who underwent 3T MRI and detailed neuropsychological assessment. ICS was defined as≥50% stenosis in any intracranial vessel on 3D Time-of-Flight MR Angiography. Gray matter sCoV and CBF were obtained from 2D EPI pseudo-continuous ASL images. Results: ICS was present in 58 (15.2%) patients. Patients with ICS had higher gray matter sCoV and lower CBF. The association with sCoV remained statistically significant after correction for cardiovascular risk factors. Moreover, ICS was associated with worse performance on visuoconstruction, which attenuated with higher sCoV. Mediation analysis showed that there was an indirect effect of ICS on visuoconstruction via sCoV. Conclusion: These findings suggest that compromised CBF as detected by higher sCoV is related to cognitive impairment among individuals diagnosed with ICS. We also showed that sCoV partially mediates the link between ICS and cognition. Therefore, sCoV may provide valuable hemodynamic information in patients with vascular disease.

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Cortical microinfarcts in memory clinic patients are associated with reduced cerebral perfusion

Journal of Cerebral Blood Flow & Metabolism ◽

10.1177/0271678x19877403 ◽

2019 ◽

Vol 40 (9) ◽

pp. 1869-1878 ◽

Cited By ~ 5

Author(s):

Doeschka A Ferro ◽

Henri JJM Mutsaerts ◽

Saima Hilal ◽

Hugo J Kuijf ◽

Esben T Petersen ◽

...

Keyword(s):

Arterial Spin Labeling ◽

Cerebral Perfusion ◽

Region Of Interest ◽

Resonance Imaging ◽

Memory Clinic ◽

Anterior Circulation ◽

Cortical Gray Matter ◽

Arterial Transit Time ◽

Magnetic Resonance Imaging Mri ◽

Continuous Arterial Spin Labeling

Cerebral cortical microinfarcts (CMIs) are small ischemic lesions associated with cognitive impairment and dementia. CMIs are frequently observed in cortical watershed areas suggesting that hypoperfusion contributes to their development. We investigated if presence of CMIs was related to a decrease in cerebral perfusion, globally or specifically in cortex surrounding CMIs. In 181 memory clinic patients (mean age 72 ± 9 years, 51% male), CMI presence was rated on 3-T magnetic resonance imaging (MRI). Cerebral perfusion was assessed from cortical gray matter of the anterior circulation using pseudo-continuous arterial spin labeling parameters cerebral blood flow (CBF) (perfusion in mL blood/100 g tissue/min) and spatial coefficient of variation (CoV) (reflecting arterial transit time (ATT)). Patients with CMIs had a 12% lower CBF (beta = −.20) and 22% higher spatial CoV (beta = .20) (both p < .05) without a specific regional pattern on voxel-based CBF analysis. CBF in a 2 cm region-of-interest around the CMIs did not differ from CBF in a reference zone in the contralateral hemisphere. These findings show that CMIs in memory clinic patients are primarily related to global reductions in cerebral perfusion, thus shedding new light on the etiology of vascular brain injury in dementia.

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Time-resolved, contrast-enhanced 3D MR angiography in the subclavian steal effect

VASA ◽

10.1024/0301-1526/a000009 ◽

2010 ◽

Vol 39 (1) ◽

pp. 85-93 ◽

Cited By ~ 1

Author(s):

Schubert

Keyword(s):

Mr Angiography ◽

Time Resolved ◽

Time To Peak ◽

Vertebral Arteries ◽

Subclavian Steal ◽

Cerebrovascular Events ◽

Graphic Analysis ◽

Contrast Enhanced ◽

Hemodynamic Information ◽

Supraaortic Vessels

The subclavian steal effect indicates atherosclerotic disease of the supraaortic vessels but rarely causes cerebrovascular events in itself. Noninvasive imaging providing detailed anatomic as well as hemodynamic information would therefore be desirable. From a group of 25 consecutive patients referred for MR angiography, four with absent or highly attenuated signal in one of the vertebral arteries on 3D multislab time-of-flight MR angiography were selected to undergo 3D time-resolved contrast-enhanced MR angiography. The time-resolved 3D contrast series (source images and MIPs) were evaluated visually and by graphic analysis of time-intensity curves derived from the respective V1 and V3 segments of both vertebral arteries on the source images. In two cases with high-grade proximal left subclavian stenosis, time-resolved 3D ce-MRA was able to visualise retrograde contrast filling of the left VA. There was a marked delay in time-to-peak between the left and right V1 segments in one case and a shallower slope of enhancement in another. In the other two cases, there was complete or collateralised segmental occlusion of the VAs.

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Lobar Distribution of Changes in Gray Matter and White Matter in Memory Clinic Patients: Detected Using Magnetization Transfer Imaging

American Journal of Neuroradiology ◽

10.3174/ajnr.a0687 ◽

2007 ◽

Vol 28 (10) ◽

pp. 1938-1942 ◽

Cited By ~ 13

Author(s):

A.C.G.M. van Es ◽

W.M. van der Flier ◽

F. Admiraal Behloul ◽

H. Olofsen ◽

E.L.E.M. Bollen ◽

...

Keyword(s):

White Matter ◽

Gray Matter ◽

Magnetization Transfer ◽

Magnetization Transfer Imaging ◽

Memory Clinic

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Mixed-location cerebral microbleeds as a biomarker of neurodegeneration in a memory clinic population

Aging ◽

10.18632/aging.102478 ◽

2019 ◽

Vol 11 (22) ◽

pp. 10581-10596

Author(s):

Bibek Gyanwali ◽

Muhammad Amin Shaik ◽

Chuen Seng Tan ◽

Henri Vrooman ◽

Narayanaswamy Venketasubramanian ◽

...

Keyword(s):

Cerebral Microbleeds ◽

Memory Clinic ◽

Clinic Population

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P1-371: New research criteria for the diagnosis of Alzheimer's disease applied in a memory clinic population

Alzheimer s & Dementia ◽

10.1016/j.jalz.2008.05.953 ◽

2008 ◽

Vol 4 ◽

pp. T327-T328 ◽

Cited By ~ 1

Author(s):

Femke H. Bouwman ◽

Nicolaas A. Verwey ◽

Martin Klein ◽

Yolande A.L. Pijnenburg ◽

Astrid Kok ◽

...

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Memory Clinic ◽

New Research ◽

Research Criteria ◽

Clinic Population

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O5-02-02: Concordance between CSF biomarkers and [11C]PIB PET in a memory clinic population

Alzheimer s & Dementia ◽

10.1016/j.jalz.2013.04.476 ◽

2013 ◽

Vol 9 ◽

pp. P830-P830 ◽

Cited By ~ 1

Author(s):

Marissa Zwan ◽

Argonde van Harten ◽

Rik Ossenkoppele ◽

Femke Bouwman ◽

Charlotte Teunissen ◽

...

Keyword(s):

Csf Biomarkers ◽

Memory Clinic ◽

Clinic Population

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Brain function monitoring during off pump cardiac surgery: the effect of cardiac output on cerebral perfusion in a patient with severe extracranial vascular disease

European Journal of Anaesthesiology ◽

10.1097/00003643-200606001-00093 ◽

2006 ◽

Vol 23 (Supplement 37) ◽

pp. 26

Author(s):

P. Zanatta ◽

C. Valfrè ◽

E. Bosco ◽

V. Salandin ◽

M. Sarpellon ◽

...

Keyword(s):

Cardiac Output ◽

Cardiac Surgery ◽

Vascular Disease ◽

Brain Function ◽

Cerebral Perfusion ◽

Off Pump ◽

Brain Function Monitoring

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Cerebral White Matter Lesions have Low Impact on Cognitive Function in a Large Elderly Memory Clinic Population

Journal of Alzheimer s Disease ◽

10.3233/jad-171111 ◽

2018 ◽

Vol 63 (3) ◽

pp. 1129-1139 ◽

Cited By ~ 3

Author(s):

Jules J. Claus ◽

Mirthe Coenen ◽

Salka S. Staekenborg ◽

Jacqueline Schuur ◽

Caroline E.M. Tielkes ◽

...

Keyword(s):

Cognitive Function ◽

White Matter ◽

White Matter Lesions ◽

Cerebral White Matter ◽

Memory Clinic ◽

Cerebral White Matter Lesions ◽

Clinic Population

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Arterial spin labeling magnetic resonance imaging at short post-labeling delay reflects cerebral perfusion pressure verified by oxygen-15-positron emission tomography in cerebrovascular steno-occlusive disease

Acta Radiologica ◽

10.1177/0284185120917111 ◽

2020 ◽

pp. 028418512091711

Author(s):

Hiroshi Itagaki ◽

Yasuaki Kokubo ◽

Kanako Kawanami ◽

Shinji Sato ◽

Yuki Yamada ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Blood Flow ◽

Arterial Spin Labeling ◽

Cerebral Perfusion ◽

Perfusion Pressure ◽

Spin Labeling ◽

Occlusive Disease ◽

Resonance Imaging ◽

Arterial Transit Time ◽

The Right

Background Arterial transit time correction by data acquisition with multiple post-labeling delays (PLDs) or relatively long PLDs is expected to obtain more accurate imaging in cases of the cerebrovascular steno-occlusive disease. However, there have so far been no reports describing the significance of arterial spin labeling (ASL) images at short PLDs regarding the evaluation of cerebral circulation in ischemic cerebrovascular disease. Purpose To clarify the role of short-PLD ASL in cerebrovascular steno-occlusive disease. Material and Methods Fifty-three patients with cerebrovascular steno-occlusive disease were included in this study. All patients underwent ASL magnetic resonance imaging and 15O-PET within two days of each modality. To compare the ASL findings with each parameter of PET, the right-to-left (R/L) ratio, defined as the right middle cerebral artery (MCA) value/left MCA value, was calculated. Results There is a significant correlation between the ASL images at a short PLD and the ratio of cerebral blood flow and cerebral blood volume by 15O-PET, which may accurately reflect the cerebral perfusion pressure. A receiver operating characteristic curve analysis indicated that ASL images at PLD 1000 and 1500 ms were more accurate than at PLD 2000–3000 ms for the detection of a ≥10% change in the PET cerebral blood flow. Conclusion ASL images at shorter PLDs may be useful at least as a screening modality to detect the changes in the cerebral circulation in cerebrovascular steno-occlusive disease. We must evaluate ASL images at multiple PLDs while considering the arterial transit time of each case at present.

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